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When Should Children Take Part in Medical Decisions?

Pediatricians sometimes find ourselves holding small children down and treating them against their will. When cleaning the wax out of a toddler’s ear, for example, to see if there’s an infection, we don’t ask the child’s opinion.

But as children grow up, how can they, and how should they, begin to participate in making medical decisions? What if they disagree with their parents, or with their doctors? When do they get to decide whether to have elective surgery, whether to go on medication for attention deficit disorder, whether to undergo medical tests or treatments or just wait to see whether their symptoms clear up on their own?

The American Academy of Pediatrics last month issued a new policy statement, with an accompanying technical report, analyzing the issue of informed consent by pediatric patients. It discusses the question of formal informed consent, but also the question of assent, suggesting that even a child as young as 7 can express an informed agreement with proposed medical treatment, and that if the child is properly informed and involved in the discussion, this can “foster the moral growth and development of autonomy in young patients.”